“You don’t need a special skill—you just spray it in the nose. And everybody’s got a nose.”
The quote above is from Joseph D’Agosto who is a paramedic on Staten Island. He describes his experience with working with Narcan, a nasal-spray syringe. He was able to use Narcan to reverse the overdose of a lady who had been found unresponsive in the courtyard of an apartment of a building. Previously, when someone like D’Agosto had to help an overdose victim, the overdose reversal drug had been administered through an IV. This was a disadvantage, as the IV is harder to use due to the fact that it can be hard to find a vein and the situations are not always in the most sterile areas. However, Narcan is much easier to administer, as the only steps to administer it are placing the nozzle in the nose and pressing the plunger to release the medicine into the body. Although I had understood the basic function of Narcan, I never understood how important it is or how widely it is used. In Narcan, the antagonist drug is an opioid called naloxone which is highly soluble in blood and can instantly reverse the effects of opioids (Frazier, 2015). Tests showed it to be more potent at reversing the effects of opioids than any antagonist synthesized so far. Naloxone also often does not combine with other drugs to create bad effects and has very rare serious side effects. Although it has the ability to displace opioids, there are no other opioids that displace it. It is also non-addictive so it cannot be abused, unlike Subutex which is pure buprenorphine (Hatcher, Mendoza, and Hansen, 2018). The safety that Narcan provides is revolutionary, as previously there were opioid reversal drugs, but they came with a variety of scary side effects or addictive properties (Hatcher, Mendoza, and Hansen, 2018). The drug is best absorbed in the body when it is administered through the nose. Most overdoses involve multiple drugs, but naloxone works only on opioids. Alcohol, cocaine, and benzodiazepines like Valium are unaffected by it (Frazier, 2015). The invention of Naloxone also led to discoveries about how opioids and drugs impacted the brain. When it was found that electronically stimulated pain relief could be reversed by naloxone, it was discovered that there may be chemicals in the body that provide pain relief and pleasure like opioids (for example, endorphins) (Frazier, 2015). A number of such natural chemicals were later found along with receptors in the brain upon which they and the opioids acted (Frazier, 2015). Given this, Narcan seems like a miracle drug that should be able to solve all issues with the opioid epidemic. However, the experience of having Narcan reverse an overdose is not a particularly pleasant experience. Due to the fact that Narcan immediately stops the high the user experiences, they undergo sudden detox and face the sheer pain of withdrawal which lasts anywhere from thirty to ninety minutes (Frazier, 2015). One woman described the experience of being revived by Narcan as, “all I remember is waking up and feeling so horrible that I thought the people I was with were being mean to me...it was very, very painful, like twenty times worse than the worst flu I ever had.” Despite this, she was grateful that the naloxone saved her life.
Although it may generate this unpleasant reaction, Naloxone is safely given to a wide range of patients from newborns to elderly folk. Naloxone is given to newborns whose mothers have had opioid painkillers during childbirth, so the opioid won’t suppress the babies’ breathing. Postoperative patients sometimes are brought out of anesthetic with naloxone. Even patients suffering from dissociative disorder, which often causes everything around them to seem unreal, can be treated with naloxone. Anybody can use it to revive an overdose victim with little fear of causing injury. After reading this article, I wondered what the effect of having to regularly administer Narcan on personnel like D’Agosto. Are there shortages of first responders due to this crisis? I also wondered about the affordability of Narcan and if that played a role in why suboxone and other alternatives still exist? Why is it not possible to develop a pill form of Narcan that can be used for longer-term opioid management rather than having patients use suboxone when it has addictive buprenorphine? Relatedly, I was also curious about the Supervised Injection Facilities (SIFs). I wondered why the SIF’s weren’t implemented in the US, but my further research seemed to suggest that there were a lot of political motives not to start these facilities in the US. For example in Indiana, Mike Pence did not support a related safety measure, needle exchanges, despite the fact that there were many consequences including an HIV outbreak (Gonsalves and Crawford, 2020). In order to be successful, politicians are often more concerned with their public appearance of being “hard on drugs and crime,” even if they are not helping the situation.
References AH;, D. P. (2018, March). Using drugs in un/safe spaces: Impact of perceived illegality on an underground supervised injecting facility in the United States. Retrieved July 21, 2020, from https://pubmed.ncbi.nlm.nih.gov/29278831/ Frazier, I. (2015, September 1). The Antidote. Retrieved July 21, 2020, from https://www.newyorker.com/magazine/2014/09/08/antidote Gonsalves, G. S., & Crawford, F. W. (2020, March 2). How Mike Pence Made Indiana's HIV Outbreak Worse. Retrieved July 21, 2020, from https://www.politico.com/news/magazine/2020/03/02/how-mike-pence-made-indianas-hiv-outbrea k-worse-118648 Hatcher, A. & Mendoza S. & Hansen H. (2018, January 28). At the Expense of a Life: Race, Class, and the Meaning of Buprenorphine in Pharmaceuticalized "Care". Retrieved July 21, 2020, from https://pubmed.ncbi.nlm.nih.gov/29161171/ Nickerson, J. W., & Attaran, A. (2012, January). The inadequate treatment of pain: Collateral damage from the war on drugs. Retrieved July 21, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3254657/
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